Monday, February 28, 2011
The February issue of Diabetes Care carried the awaited publication of RABBIT2 Surgery which compares the efficacy and safety of basal/bolus insulin with sliding scale insulin in the general surgical non-ICU patient.
In this multicenter randomized controlled trial, subjects received either scheduled basal/bolus insulin (n104) from a weight based calculation or sliding scale insulin alone (n107). The average glucose on day one for basal/bolus was 145 ± 32 compared to 172 ± 47 (p<0.001). Notably among subjects in the basal/bolus group glycemic control was achieved earlier and better maintained. In addition, significantly fewer complications were seen in the basal/bolus group (OR 3.39; 95% CI 1.5-7.95). No mortality benefit was seen.
Euglycemia for surgical inpatients, even non-ICU, is demonstrated to correlate with outcomes. Moreover, this study supports the practice of using a physiologic based methods for insulin administration–basal/bolus–rather than the reactive sliding scale.